UNTINGTON, W.Va. — The white car had stopped in the middle of the highway. The driver was slumped behind the wheel, her breaths faint and few.

Her head was bobbing, chin to chest; her pupils were the size of a pinpoint. The car was strewn with syringes. Paramedics inserted a needle of naloxone, an opioid antidote, into her left arm — the one with fewer scars. A minute passed. Two. At last, Taylor Wilson’s eyes flickered opened below the bright ambulance lights.

Taylor’s overdose was the first of 28 that would be reported in this small city on the Ohio River in the span of five hours on Aug. 15, 2016. Frantic calls flooded in to 911: Heroin users were passed out on dining room floors and in convenience store bathrooms. “People are coming here and dying,” one caller said. The horror of that afternoon made national news: CNN, Fox News, Associated Press, the Los Angeles Times.

Then the reporters left. Taylor’s story, though, was just beginning.

Her parents, John and Leigh Ann Wilson, would spend the next 41 days trying to get help for their blue-eyed bookworm, who had recently turned 21. They drove door to door in search of inpatient treatment beds to isolate Taylor from her heroin world. They sought out medicine to curb her cravings. They even wrestled with whether to have their daughter involuntarily committed to a hospital.

As longtime health care professionals, the Wilsons thought they knew how to navigate the system. Leigh Ann had worked for years as a paramedic before becoming a home health worker; John was the lead residential therapist at an Ohio facility for troubled adolescent boys. They both had a sense of the hard road ahead.

But for 41 days, they ran into roadblocks far greater than they’d ever imagined.

On the 42nd, a beautiful Sunday in late September, Taylor Wilson overdosed again. This time, no one was able to call 911 in time.

Leigh Ann and John Wilson play back those 42 days in a constant loop. They remember the clinics with lengthy waiting lists; the treatment centers that wouldn’t take Medicaid; the doctors who discouraged Taylor from inpatient treatment, saying she could do without it. They wonder, more than anything, why it’s so hard to get addiction treatment in the state with the nation’s highest drug death rate — 818 deaths last year, most of them from opioids.

“There doesn’t seem to be enough emphasis on what we’re losing.”

John Wilson

Here in Huntington, population 49,000, health officials estimate a staggering 1 in 4 residents is dependent on opioids, from squalling newborns shaking with withdrawal symptoms to powerful lawyers immobilized by addiction. It’s so bad that the mayor carries around a naloxone injector in case he encounters an overdose victim. The city has tried setting up a needle exchange, hiring a drug czar, even suing the drug companies that brought pain pills to the state of West Virginia. None of those tactics have stopped the epidemic.

“There doesn’t seem to be enough emphasis on what we’re losing,” John Wilson said, fighting the tears falling down his face.

His daughter had been a Girl Scout. She’d loved to ride horses. He thought she even had the potential to play soccer in college. Taylor loved words — reading others’ and writing her own — so much that she wanted to become a librarian.

Now she was in the throes of an addiction she could not shake, and no one seemed able to offer any more help than a syringe full of naloxone.

“This pain has gone too far,” John Wilson said.

John Wilson, a therapist who works with troubled boys, couldn’t find his daughter Taylor adequate addiction treatment.

‘You’re going to get her back in a pine box’

The overdose that left Taylor slumped behind the wheel of her white Kia Soul was her third in a year.

Her dad had found her after her first, back in the summer of 2015. He’d heard a loud thump in the lower level of his house. Taylor was unconscious. After her second, in March of last year, Leigh Ann had received an anonymous call saying Taylor had recently entered cardiac arrest and almost died.

“If you don’t pick your daughter up,” the caller said, “you’re going to get her back in a pine box.”

Leigh Ann placed Taylor on leave from her college classes at Marshall University in Huntington and her job at the Wendy’s drive-through window. She made countless calls before she found a bed at Karen’s Place, an all-women’s Christian treatment center in a lakefront lodge just across the Kentucky state line. The Wilsons scraped together $4,000 for a 28-day inpatient program that included counseling, spiritual mentoring, and Narcotics Anonymous meetings. Patients were only allowed to receive visitors every two weeks and make 15 minutes’ worth of phone calls every seven days, much to Taylor’s frustration.

With 12 days left, Taylor checked herself out. She soon got back together with her boyfriend, who had a long rap sheet of drug possession offenses and was also addicted.

The following month, Taylor turned 21. She celebrated her birthday with a new hairdo, paid for by her mother — and later that day, with heroin.

The Marcum Terrace housing complex in Huntington, a hot spot for heroin distribution, is where Taylor bought heroin.

The overpass in Huntington that Taylor was driving on when she overdosed on Aug. 15, 2016.

A shortage of treatment beds

Her addiction, like so many others, had started with prescription pain pills. But as lawmakers cracked down on pill mills, drug users across the state and the nation turned to heroin. Taylor did, too. It was more convenient to get, and often cheaper. It was also more deadly, especially when spiked with synthetic opioids like fentanyl or an elephant tranquilizer known as carfentanil, so potent that a dose the size of two salt grains could kill.

Spiked batches of heroin had the potential to ravage a whole town. One day last summer, there were 17 overdoses in Akron, Ohio. Another day, there were 10 in Columbus, Ohio. The cluster in Huntington was one of the worst. Two of the 28 drug users who overdosed on that day died. And many who survived got no treatment beyond the jolt of naloxone to revive them.

That’s a familiar problem. West Virginia officials estimate 150,000 residents — 8 percent of its population — needed substance abuse treatment in 2016. Just a fifth received help from treatment providers belonging to the state’s top behavioral health association. And only 156 detox beds were available across the entire state.

“There are not enough resources available,” said Kim Miller, director of corporate development at the Prestera Center, West Virginia’s largest behavioral health service provider. “There’s a workforce shortage. If we could pay people better, we could have a more robust workforce — more docs, more psychiatrists, more counselors — and more treatment.”

Last May, Taylor checked herself out early from Karen’s Place, a rehab facility in Louisa, Ky. Her parents didn’t have the money to send her back in August.

‘It has to stop here’

After her third overdose, when her car stopped on the bridge in the middle of traffic, Taylor called her mom from St. Mary’s Medical Center. The paramedics had brought her there, and she needed a ride home.

In the emergency room, Leigh Ann found Taylor sitting in a hospital gown, chatting about her car, her job, her boyfriend, as if everything were normal. It was too much for her mother. “It has to stop here,” she thought to herself.

At wit’s end, Leigh Ann asked John if they should involuntary commit Taylor to a psychiatric hospital by way of a legal document known as a mental hygiene order. John knew such an order would have repercussions; their daughter could lose her ability to own a gun or hold government jobs requiring security clearance. But Leigh Ann reasoned that such consequences wouldn’t matter if they had to bury Taylor.

And, since Taylor right then didn’t get the gravity of her addiction, they feared her release from St. Mary’s could amount to a death sentence.

A judge met with Taylor in the hospital and presented two options: comply with your parents, avoiding a messy court hearing, or defend your competency in court. Taylor chose the former.

Before dawn on Aug. 16, a police officer transported Taylor in handcuffs to Charleston’s Highland Hospital for detox. The lead psychiatrist there diagnosed Taylor with addiction and depression.

But she thought Taylor had a shot at recovery if she could break out of a codependent cycle of using drugs with her boyfriend. Leigh Ann worried that Taylor’s first call from the detox center was to her boyfriend — but drove out there regardless to bring her clean clothes.

Leigh Ann thought Taylor, once detoxed, should enter a residential recovery program. Four years earlier, Leigh Ann had admitted herself to Prestera’s inpatient treatment center for alcoholism and depression. Knowing her daughter, she doubted anything less would cut it.

Highland’s psychiatrist, however, decided Taylor should be released after seven days with a recommendation for intensive outpatient counseling. That isn’t uncommon: It’s hard for providers to get insurers to pay for more than a week to 10 days of inpatient treatment. A Highland Hospital spokesperson declined to discuss Taylor, citing privacy regulations, but said in a statement that “each patient’s treatment is based on that patient’s clinical needs.”

Leigh Ann disagreed. Taylor had already overdosed at least three times. Her relationship with her boyfriend fueled and reinforced her addiction. Leigh Ann knew deep down that outpatient counseling wouldn’t be enough for her daughter.

‘Most of the people on that list will die’

Days after her discharge, Taylor received even more bad news: She had contracted hepatitis C, likely as the result of sharing needles with her boyfriend. It could be treated, but she’d have to stay away from needles. She believed medication-assisted treatment was necessary to help her withstand withdrawals.

“It’s the only way I’ll make it,” Taylor told her mother.

Evidence suggests that the combination of counseling and prescription drugs to reduce cravings can be more effective than abstinence or 12-step programs. But West Virginia lawmakers, concerned users might trade one addiction for another, have restricted the availability of medication. The demand for treatment has far outstripped supply.

Taylor put her name on Prestera’s waiting list for Suboxone, an opioid-based drug to reduce withdrawal symptoms. No one told her how long she might have to wait, but she’d heard it could be months.

“There aren’t enough resources to accommodate the addiction problem in the heroin capital of the U.S.,” Taylor later wrote to a reporter. “If no one changes it this whole city will go under.”

While she waited for treatment, Taylor had agreed to live at her father’s house, located in a secluded part of Barboursville, the quiet suburb outside Huntington where both John and Leigh Ann had settled after their divorce years earlier.

John Wilson at his home in Barboursville, W.Va.

She had two conditions: access to library books and the ability to write back to her friend John Stiltner II, a recovering heroin addict who’d sent her a letter during her hospital stay. John Wilson had strict rules — no computer, no cellphone, and no car — but agreed to those conditions if he could read Taylor’s letters before she mailed them.

Taylor’s recent overdose weighed on her father’s mind. During her stay at Highland, he’d picked up her Kia Soul from the impound lot, where the police had written “N-E-E-D-L-E-S” on the windshield as a safety precaution. Driving home, he had felt overcome with emotions — anger, confusion, embarrassment, and sadness — but cleaned out the syringes to keep his daughter safe. John had Taylor wipe the letters off the windshield.

In late August, John decided to keep his long-standing plans for a vacation. He couldn’t trust Taylor at home alone, so he asked her to stay with her mother. The day Leigh Ann picked up Taylor, their daughter seemed giddy and her eyes looked dilated.

Leigh Ann wondered if, despite all their rules, Taylor had somehow found a way to get high.

Back at her mom’s house, Taylor kept her head down in World War II books. And she kept in touch with Stiltner through letters and text messages on a phone she had managed to keep hidden from her dad.

“Sorry my handwriting sucks, my hands have been really shaky lately,” Taylor wrote to John the week after leaving Highland. “Can you send me [N.A.] meeting times? … I think it would help me.”

Taylor started attending N.A. meetings three times a week and looking for a sober living apartment. But the meetings only did so much as life around her grew more stressful.

Taylor had helped identify the Ohio dealer who allegedly sold her heroin on the day she overdosed. It was that same batch of drugs, apparently spiked with synthetic opioids, that had killed two and sent 25 others to the brink of death on that August day. Taylor was expected to testify against the dealer later in the month; if she failed to show up, she could end up in jail.

Lt. David McClure, a Cabell County EMS paramedic, revived Taylor after she overdosed in her car on Aug. 15, 2016.

If that wasn’t enough, CNN ran a story about the brutal afternoon in Huntington. It described the way she looked after her overdose: drool dribbling from her mouth, a syringe in her lap. Taylor had a hard time reading that. She was upset, too, to read a comment from Lt. David McClure, the senior paramedic who’d revived her. He said no overdose victim had ever thanked him.

She bought McClure a peach-scented Yankee Candle in hopes of being the first.

To help Taylor out, Leigh Ann scheduled appointments with both a physician and psychiatrist. And, still hoping her daughter could get inpatient treatment, she called Karen’s Place, the center where Taylor had stayed briefly after her second overdose.

They had open beds, a staffer said, but there was another problem. Taylor got her insurance through West Virginia’s Medicaid and the facility, despite being less than 50 miles away, was in Kentucky. It couldn’t accept West Virginia Medicaid. Leigh Ann and John no longer had the money to pay the thousands of dollars out of pocket.

By this time, Taylor had come around to her mother’s belief that a bed in a supervised facility was better than outpatient care. She talked to a crisis counselor at Prestera, admitting that a few days earlier she’d relapsed with a small amount of heroin that made her vomit. The counselor advised her to call the following day at 8:01 a.m. to see if any beds had opened.

The sun was on the cusp of rising the next day as they readied for their mission. Before 8 a.m., Leigh Ann pulled out of the driveway, heading toward Prestera, ready to drop Taylor off immediately if beds were available. At 8:01 a.m., Taylor called. No beds were open. A crisis counselor urged her to consider intensive outpatient treatment instead. Her dope sickness, the counselor said, “wasn’t that bad.” Taylor was beside herself: How could they say she wasn’t bad enough?

Despite her distress, Taylor dialed down a list of nearly three dozen treatment centers. Time and again, she got either voicemail or receptionists saying they were full for the day. Try again tomorrow, they said.

“ALL the beds were full,” Taylor wrote to a CNN reporter. “The waiting list for the one rehab in H-town (ironic nickname huh) is extremely wrong. Most of the people on that list will die before they get the chance for treatment.”

The house where Taylor died on the morning of Sept. 25, 2016, in Barboursville, W.Va.

A letter written to the Wilson family from an employee at Prestera, one of the area’s biggest rehab facilities. Taylor tried to get medication-assisted treatment there, but the waiting list was too long.

A quick exchange at a stop sign

Her friends back at Marshall were well into their fall semester. But Taylor spent her third week in September waiting for her court appearance. After her testimony, she seemed herself, gushing to her mom about a cute detective. In that moment, Leigh Ann thought everything might be fine, so long as treatment arrived in time.

As the week drew to a close, Taylor planned on tailgating with her dad before the big Marshall homecoming game on Sept. 24. That afternoon, she asked her mom for her car keys.

“All the beds were full. … Most of the people on that list will die before they get the chance for treatment.”

Taylor Wilson

“Where are you going?” Leigh Ann asked.

“An N.A. meeting,” Taylor replied.

“It’s homecoming,” Leigh Ann said skeptically. “There are 25,000 people in town. There’s an N.A. meeting?”

“I’m positive,” Taylor said.

Leigh Ann wasn’t sure she believed her, but she wasn’t feeling well, so she didn’t put up a fight. Taylor headed out around 6 p.m. to pick up her friend John Stiltner. There was indeed an N.A. meeting, and they attended; John even texted Leigh Ann to let her know.

After the meeting, John and Taylor picked up some ice cream and cigarettes. Not ready to call it a night, they cranked the radio and, as old country music blared, cruised Huntington’s back streets. They headed east. Past the nickel plant, Taylor pulled over at a stop sign. They waited.

John had earlier noticed Taylor on the phone. He hadn’t thought much of it, until now a dealer approached Taylor’s car. It was a quick exchange: She pulled out $80, cash she’d gotten from selling pictures of herself to another man, and handed it over. The dealer gave her a half-gram of what looked like heroin.

“What the f— are you doing?” John asked.

“It’s not for me,” she replied.

John demanded to be taken home. Once Taylor dropped him off, he made a point of not texting her all night, hoping to teach her a lesson. “I was trying to get a point across: If you hang out in a barber’s shop, you’re going to get your hair cut,” John said.

A decoration that a friend put on Taylor’s gravesite; her father brought it home to repair after it was damaged.

A father who could not bear to look

Night had fallen over Barboursville by the time Taylor walked into the house where Leigh Ann planned to stay overnight to care for an elderly retired Marine. Taylor snacked on some Kroger barbecue chicken on the blue couch in the lower level. Leigh Ann walked downstairs before 11 p.m. to find Taylor watching TV.

“You look tired,” Taylor told her mom. “Why don’t you go to bed?”

With her mom gone, Taylor pulled out the drugs she had bought. The early fall evening still felt like summer, so she stood outside in the cul-de-sac just after midnight, firing off texts. A neighbor last saw her outside around 1 a.m.

As Leigh Ann woke up on Sunday, she noticed the TV’s hum. It sounded like Taylor had left it on all night. So she went to check. Taylor was slumped on the blue couch, motionless. Her legs were curled under her body. Her right arm was slung over the back of the couch. Her face leaned against her knees.

Leigh Ann touched Taylor’s skin. It was cold as ice. She fell to her knees, hoping God would take her, too.

Her dad arrived, but he couldn’t bear to look at his little girl, as authorities rolled her body bag down the driveway.

The autopsy would later conclude that Taylor had died of an overdose of opioids — fentanyl, carfentanil, furanyl fentanyl, morphine, and hydrocodone. But no heroin.

The night Taylor overdosed, Leigh Ann sat in the lower level, curtains closed, and downed four beers. It was her worst relapse since her treatment for alcoholism. She hardly ate or slept for three days. On the fourth, she pulled it together to plan Taylor’s funeral and purchase cemetery plots for her daughter and herself.

Before she left home, Leigh Ann’s cellphone rang.

The voice on the other end, full of excitement, had good news. Taylor had cleared the Suboxone waiting list.

The comment that “no heroin” was found is likely incorrect. Heroin is metabolized completely into morphine, and since morphine is rarely found in street drugs, it is likely that she used heroin cut with fentanyl analogues. The other piece is that it should NOT be treatment “beds” that we are looking for, but rather treatment “slots” in the most effective forms of treatment. These happen to be what is called “medication-assisted treatments” like methadone and buprenorphine programs, which are actually far more likely to save lives than revolving door detoxes and short-term residential programs.

@Robert: with all due respect, I don’t see how you can contend that pain only exists in the brain, and not in the “part affected”. While I am no doctor or biologist or anything of that nature, I do think that it is self-evident that we humans (and all mammals for that matter) are an entity and should be regarded as such. I mean: where and what is the brain? For some people the brain ends somewhere above the neck, for others the nerve endings in your fingertips belong to your brain as well. So that is just a matter of definition. I think it’s very misleading to separate the brain from the rest of the body, because neither “brain” or “body” could function on it’s own. They depend on each other. There is no such thing as a brain without a body. We are a complete entity with body mind and soul. Your view seems to me mechanical at best. So this thing with the brain and the body to me is actually a non-issue. Pain (or the perception of pain) as you correctly point out does actually vary from culture to culture, but it also varies from individual to individual. You yourself claim that you can handle pain very well and do not, would not, consider medicating yourself in order to lessen it. Very well and good for you. You are to be envied. On the other hand, it’s dangerous to reason that just because you are able to handle pain so well, that other people should be able to do the same. Everyone is different. Every life is a different life, everyone’s perception of life or what gives them meaning is different. Values differ from person to person. So I don’t think it is justified to make the generalizations you make.

I more than agree with you, it is my conviction that this opioid epidemic could not exist without the greed by which it is driven. The greed of the drug manufacturers claiming that their drug oxycontin was not addictive. The claim of those who represented Purdue, who lied this lie a thousand times to doctors all over the United States (read the brilliant and detailed account of how this came to be: Dreamland by Sam Quinones.) They in turn prescribed this drug to their patients for minor pain such as toothaches, back pain and such. That’s how alot of Americans got addicted in the first place. Of course you also had the guys from Mexico selling their very cheap and potent black-tar heroin. Especially when realization dawned that the heroin in question was even more potent than the oxycontin but at the same time much cheaper. They are also to blame. And sure, as every individual must take responsibility for his or her actions, so yes the addicted must do the same regarding their ailment. But what is so wrong and so cruel about this is the fact that addicts get criminalized instead of getting real help. I wrote about all this before, I don’t want to get into it again. There is just one more point that I want to make: just because someone gets addicted to opioids, does not make them weak-willed losers. There are lots of people who made valuable contributions to society who have succumbed to and died of this terrible epidemic. Here, first and foremost I think of Prince. Before he died, I did not know that there was an opioid epidemic in the USA (I live in Switzerland). Here in Switzerland there was a similar problem going on in the 80’s. Maybe you heard of “Needle Park” in Zurich? People were shooting up and dying by the hundreds. The place was littered with needles. It was horrible. After a couple of years of just trying to police the problem away, the authorities became creative and started to offer the addicted heroin and clean needles. That certainly did not solve the problem of addiction per se, but at least here in Switzerland no one has been dying of overdoses and other drug related ailments. I myself am just thankful that I’ve never tried an opiate, I am sure that if I had, I would not have written this. All the best to you, Robert!

I am a physicist, not a natural scientist. In my world, if you can’t predict and duplicate 100%, you don’t know what’s going on. The natural sciences have no such luxury. With the help of the physical sciences, almost all the advances in medicine have been based on developments in the physical sciences, optical imaging, thermal probes, ultrasound, MRI, the list goes on. Eventually, someone will get a probe for the brain where we can see, and predict, responses. Maybe the addicts brain is different. Re pain, there was no one who was a bigger wimp than me when I was a child.I was terrified of the dental drill. As a result, I lost teeth. I enlisted in the Navy in WW2. The first night, I got 3 teeth pulled. In boot camp, a butcher dentist drilled into the nerve without anesthesia. It felt like someone had hit me on the head with a huge rubber mallet. I was literally blind and deaf. I saw flashing lights, like an aurora, heard sounds that don’t exist, and was alone somewhere in outer space. it lasted I think, for maybe 15-20 seconds. Slowly, I regained consciousness. The butcher wanted to pull the tooth and I said you’re not going to touch me, Sir. I was sent to the brig for refusing to obey an order. The tooth was pulled by a dentist at another base ( Great Lakes has 5 ). After that, my whole perception of pain changed. As I told my eldest daughter, married to a dentist, terrified of dental work, you have to become part of the process. I had a loose tooth due to infection. The dentist said a green fracture could save it. It means driving a chisel up into the upper jaw and spreading the bone. Done under anesthesia of course. I visualized the chisel spreading the bone until the roots touched. It took 2 1/2 hours, repeated x-rays. My dentist looked like he’d been on an all-night binge. I went out, played pac-man at the Mall, did some shopping. I took ibuprofen for the soreness. It did not feel good but it wasn’t anywhere near disabling. There is no exaggeration here. I had experienced the worst pain any dental work could inflict, and survived. After that, any pain was manageable. Without narcotics. My perception of pain was altered basically, not superficially. The explosion in my brain in the Navy, was not in the nerve in the tooth. It was built up of many years of fear in my brain. I’m not suggesting that repeat of that now would be only a minor annoyance. But I know that everything since then is completely different because of the way I have taught myself to perceive it. I’m not recommending this for everyone but there’s a lesson here.

Pain is pain!!!! Not at all helpful. The fact that pain is perceived by the brain and does not exist in the part affected is the reason that mind-altering drugs work. And pain varies from culture to culture, which would hardly be the case if it were local. Our collective physiologies aren’t that different. The fact that pain is a problem of far lesser magnitude in many other cultures ought to give you a clue.

Despite the tendency to hyperbole, you have valid points. We have an induced drug culture. There was nothing like this when I was a kid. It arose from greed, the same greed that pervades our businesses and government. It’s not going to go away – on the contrary, it’s getting worse. Just as in the Spanish flu, which killed 100 million people ( estimated ) who were too weak to fight it, the same applies here. I haven’t heard of vaccinations for heroin, or any other drug for that matter, that really work. Hand wringing, prayers, counselling etc may all have a positive effect but I’m not betting on any changes of consequence.